A Retrospective Study Of Serious In-patient Cases Of Dermatological Department In The Recent Ten Years

Objective:Based on the investigation of 164 in-patient cases of serious patients in the Department of Dermatology of The First Hospital Of China Medical University in the recent 10 years,analyzing the clinical characteristics,serious causes,causes of death,treatment and outcome of the hospitalized critical cases.Methods: Collecting the patients who were First class nursed in the Dermatology Department of The First Hospital Of China Medical University from November 1,2008 to October 31,2018.gender,age,length of stay,primary diseases,concomitant diseases,length of first class nursing days,treatment,treatment affect,cause of death,the time from rash to death,outcome and other items were registered.We inputed the data of patients into Excel software,and established the case database of serious inpatients,Excel and SPSS25.0 software were used to establish the database of cases,and the collected data was analyzed statistically.Results:The ratio of male to female was 1.22:1 of the 164 serious inpatients,Ages range from 1 to 94,and the mean age was 56.34±20.15 years old.The proportion of people over 60 years old was 48.78%(80 cases).The primary types of dermatology in serious cases were drug eruption,erythroderma,bullous disease and connective tissue disease.The most common concomitant diseases of serious cases were hypertension,kidney damage,ion disorder,coronary heart disease,diabetes mellitus,hypoproteinemia,The most common serious causes were renal insufficiency,respiratory failure,nervous system damage,arrhythmia and pulmonary infection.In serious cases,drug eruption patients were the most,and the top five sensitizing drugs were anti infective drugs,antipyretic and analgesic drugs,anti epileptic drugs,traditional Chinese medicine,and anti gout drugs.In terms of treatment,119 patients(72.56%)were treated with glucocorticoids,and 67 patients(40.85%)were treated with large dose of prednisone(>60mg/d).A total of 44 patients(26.83%)were treated by intravenous immunoglobulin.14 cases(8.54%)were treated with methylprednisolone impact therapy.There were 45 cases(27.44%)with secondary infection and the top three diseases were dermatomyositis,bullous disease and erythroderma.118 patients(71.95%)were discharged after improvement,22 patients(13.41%)were transferred to other hospitals,2 patients(1.22%)were transferred to ICU,11 patients(6.70%)gave up treatment,and 11 patients(6.70%)died.Among the 11 dead patients,Bullous diseases,connective tissue diseases and drug eruption were the most common diseases,7 patients(63.64%)died of primary dermatologic diseases and complications,4 patients(36.36%)died of multiple organ failure caused by basic diseases,The main causes of death were multiple organ failure,secondary infection,disseminated intravascular coagulation.The most common complications were respiratory failure,circulatory failure and hypoproteinemia.According to age,serious cases were divided into two groups.The proportion of infection and abnormal liver and kidney function in group ? 60 were higher than that in group < 60,the difference was statistically significant.Conclusions:1.Serious cases can occur at all ages,with a higher proportion of patients over 60 years old,and a slightly higher proportion of men than women.2.The main types of dermatology in serious cases are drug eruption,erythroderma,connective tissue disease,bullous disease and zoster.We should pay attention to the diagnosis and treatment of the above diseases.3.The most common Accompanying diseases of serious cases are hypertension,kidney damage,ion disorder,coronary heart disease,diabetes mellitus and albuminemia.The most common serious causes are renal insufficiency,respiratory failure,nervous system damage,arrhythmia and pulmonary infection.We should be alert to potential risk factors,and actively ask relevant departments for consultation to assist in diagnosis and treatment.4.Not all of the dead patients died of dermatologic diseases,63.64% of the patients died of dermatologic diseases and complications,36.36% died of multiple organ failure caused by basic diseases.The main causes of death are multiple organ failure,secondary infection and DIC.5.45 cases(27.44%)of serious cases are complicated with infection.Dermatomyositis,bullous disease and erythroderma are the top three diseases in the incidence of infection.In the process of diagnosis and treatment,we should pay attention to the prevention and control of infection.6.The incidence of infection and abnormal function of liver and kidney are higher in serious cases over 60 years old,which suggests that we should pay attention to the prevention and treatment of infection in the process of diagnosis and treatment,and regularly detect the liver and kidney function.